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Improvement of Quality Scores
Session # 298, February 15, 2019
Julie M. Montgomery, Clinical Quality Data Manager, ETSU Family Medicine
Monaco Briggs, Director of Informatics & Optimization, ETSU Family Medicine
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Julie M. Montgomery, LPN, BS
Monaco Briggs, MBA
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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<First Name> <Last Name>, <Credentials>
Salary:
Royalty:
Receipt of Intellectual Property Rights/Patent Holder:
Consulting Fees (e.g., advisory boards):
Fees for Non-CME Services Received Directly from a Commercial
Interest or their Agents (e.g., speakers’ bureau):
Contracted Research:
Ownership Interest (stocks, stock options or other ownership
interest excluding diversified mutual funds):
Other:
Conflict of Interest
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• Introductions
• Learning Objectives
• About East Tennessee State University Family Medicine
• Case Study: Improvement of Quality Scores
• Local Problems
• Steps to Improve Quality Scores
• Design & Implementation Champion Team and PDSA.
• How Health IT was Utilized:
– Smarter Measure, Gap Sheet, Pre-Visit Planning, Huddle,
Flowsheets, Forms, and reports.
• Value Derived
• Questions
Agenda
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1. Manage all patients equally regardless of insurance
carrier to escalate productivity and decrease
duplication.
2. Discuss preventative health for patients while
addressing quality metrics
3. Develop a plan that includes actionable items and
feedback from all stakeholders
Learning Objectives
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Mission of ETSU Family Medicine
"Our Mission is to provide community-focused medical
education and evidence-based, patient centered care; to improve
health in rural southern Appalachia, especially among the
underserved population; to model compassionate and efficient care
using effective communication skills; and to advance scholarly
investigation. We lead through excellence, collaboration and
innovation."
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3 Locations in Northeast
Tennessee
Bristol, Johnson City, and Kingsport
ETSU Family Physicians of Bristol
ETSU Family Medicine Associates
ETSU Family Physicians of
Kingsport
2 Counties
Washington and Sullivan
ETSU Family Medicine
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• 1976- Bristol, Johnson City, and Kingsport clinics open
• 1978- ETSU enrolls 1
st
class of medical students
• 2007- Named best rural program in the nation by National
Rural Health Association
• 2010- Health Information Technology (HIT) committee
formed to implement electronic health record (EHR) platform
• 2011- NCQA level 1 PCMH recognition (on paper)
• 2014- NCQA level 3 PCMH recognition (EHR)
• 2015- Joined ACO
• 2015- Chronic Care Management team formed
• 2017- NCQA level 3 PCMH recertification
• 2017- Clinical Quality Improvement team formed
• 2018- Currently 13 managed care contracts
Facts About ETSU Family Medicine
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Each clinic has 11 to 13 Faculty Physicians (to include a Medical and
Program Director), 18 to 22 Resident Physicians, 1 Nurse Practitioner,
Social Worker, Pharm D, and a Psychologist.
Current # of Team Members per clinic including the above and to include
Site Managers, Nurse Managers, Nurses, Patient Care Reps etc.
Bristol Family Medicine: 60
Kingsport Family Medicine: 57
Johnson City Family Medicine: 56
Administrative Staff to include Chair, Vice Chair, Executive Director,
Operations Manager, Business Manager, Quality Team, Research
Division
Total Family Medicine Employees: 185
Team Members 2018
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Local Problem
In 2014, after joining our accountable care
organization and other quality incentive programs,
ETSU Family Medicine began looking at our quality
measures. We were capturing data on quality
measures but were not seeing improvements. By the
end of 2016 & 2017, after creating better workflows,
processes, report integrity checks, and building better
databases, we were able to see significant movement
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• Opportunities were being missed while the patient was being seen
at the clinic for their appointment related to quality and
preventative health.
• Our clinics needed a more efficient way to capture patient
information related to preventative health.
• Our organization found it was difficult to keep up with the ACO
and multiple managed care organizations (MCO) to meet quality
measures.
• Reports being provided by MCO’s had a significant lag time
making it difficult to manage in real time.
Local Problem
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Design and Implementation
How HIT was Utilized
Value Derived
Steps to Improved Quality Scores
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Design & Implementation
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• Champion teams have the power to impact the success of a
project
• Accountable for the projects success
• Provides leadership of the project to the organization
Design & Implementation
Champion Team
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• A team of Physicians, Resident
Physicians, Nurses, and Front Office staff
were incorporated to develop and provide
feedback for the build and implementation
of electronic dashboards, flowsheets,
forms, huddles, pre-visit planning,
workflows and processes
Design & Implementation
Champion Team
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Responsibilities
• Determine the purpose and/or goal
• Provide background
• Create a process and environment for success
• Promote and support implementation
• Gather data supporting success or failure
• Re-evaluate and implement globally or change process
Design & Implementation
Champion Team
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Design & Implementation
Plan-Do-Study-Act
• Setting Aims
• Establishing Measures
• Selecting Changes
• Testing Changes
• Implementing Changes
• Spreading Changes
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• Plan- Meetings every month or 2 weeks
• Do- Testing with one site (Pilot site)
• Study- Gathered data and statistics
• Act- Go-live
• Ongoing audits are completed to insure compliance
Design & Implementation
Champion Team
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Design & Implementation
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How Health IT Was Utilized
Clinical Quality
Measure Form
Designated clinic
staff pulls forms.
Pre-Visit Planning
Designated clinical
staff does pre-visit
planning based on
Clinical Quality
Measure Forms.
Huddles
Designated clinical
staff takes
information to
morning and
afternoon huddles in
the clinic.
Quality Assessment
Form
Patient comes to
appointment QAF
handed to patient
to fill out.
Dashboard/
Flowsheet
QAF information
entered into EHR
Dashboard/
Flowsheet
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How Health IT Was Utilized
Smarter Measure Crosswalk
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How Health IT Was Utilized
Clinical Quality Measure (Gap Sheet)
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• Nurse prints off the Clinical Quality Measures (Gap Sheets)
• Nurse reviews the gaps and with the use of standing orders,
places orders as necessary
• If necessary, the nurse will pull records
• Nurse provides a report out during the huddle
How Health IT was Utilized
Pre-Visit Planning
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• Gap sheets are reviewed at daily huddles
• Nurse reports what they were able to order and what is still
outstanding and needs to be addressed by the physician
How Health IT Was Utilized
Huddles
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Order Groups
CDS
How Health IT was Utilized
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How Health IT Was Utilized
Quality Assessment Form and Flowsheet
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How Health IT Was Utilized
Flowsheet & Note
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How Health IT Was Utilized
Reports
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• Improved health outcomes for patients decreased risk scores by
1% each quarter over a 12-month period.
• Correlates with decreased hospital admissions and emergency
department utilization.
• Streamlining the quality measure performance financially
increased our bonus to $1,050,882.88 in one year.
Value Derived
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Value Derived
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Value Derived
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Value Derived
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Value Derived
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